Patterns of recurrence after PVI with PFA vs. CBA - insights from the SINGLE-SHOT CHAMPION trial using Continuous rhythm monitoring

Background Recurrence after atrial fibrillation (AF) ablation after pulmonary vein isolation (PVI) in patients with paroxysmal AF may have very different patterns and may differ with regards to the episode duration, the number of episodes and in total AF burden. Differences in the recurrences profiles after pulsed field ablation (PFA) and cryoballoon ablation (CBA) are incompletely understood. Methods Patients with symptomatic paroxysmal AF were randomized 1:1 to PVI using PFA or CBA. All patients received an implantable cardiac monitor (ICM) at the time of ablation, and the BP duration was 90 days. Results The primary end-point of any recurrence lasting ≥30 seconds occurred in 37.1% (n=39) in PFA and 50.7% (n=53) in CBA. Overall, the mean AF burden (%) was 1.4 (+0.4) with PFA and 1.9 (+0.4) with CBA (p=0.16). Episode number and duration largely increased with increasing AF burden as can be observed from the barcode plots (Figures 1 & 2). In patients with recurrence, the median longest AF episode duration was 216 min (IQR 34-524) with PFA and 250 min (IQR 20-660) with CBA (p=0.86). The median total number of AF episodes was 36 (IQR 4-202) with PFA and 16 (IQR 3-60) with CBA (p=0.35). Conclusion The patterns of AF recurrence in regards to episode number/ duration or AF burden do not differ between PFA and CBA after PVI for paroxysmal AF.12